British journal of anaesthesia
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Experimental evidence from a murine model of traumatic brain injury (TBI) suggests that hypothermia followed by fast rewarming may damage cerebral microcirculation. The effects of hypothermia and subsequent rewarming on cerebral vasoreactivity in human TBI are unknown. ⋯ After moderate hypothermia, rewarming exceeding the 37 degrees C threshold is associated with a significant increase in average PRx, indicating temperature-dependent hyperaemic derangement of cerebrovascular reactivity.
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Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage. ⋯ Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.
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Case Reports
Prolonged myotonia and dystonia after general anaesthesia in a patient taking gabapentin.
This is the report of a 55-yr-old female who developed severe myotonia and dystonia after general anaesthesia. Before starting on gabapentin therapy for a neuropathic pain condition, she had undergone numerous uneventful general anaesthetics. ⋯ The events were unrelated to the choice of anaesthetic or anti-emetic. The most recent event that required a protracted stay in hospital after a day-case surgery is presented in detail, and the possible mechanisms to explain the interaction are discussed.
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Out-of-hospital airway management is a critical skill, demanding expert knowledge and experience. The intubating laryngeal mask airway (ILMA) is a ventilatory and intubating device which may be of value in this arena. We evaluated the ILMA for out-of-hospital management of the difficult airway. ⋯ In this study, ventilation and intubation with ILMA was successful in all patients with difficult-to-manage airways. Our data support the use of the ILMA as rescue device for out-of-hospital airway management by staff who have appropriate airway skills and have received appropriate training.